Fillable Food Service Establishment Permit Application (Pinellas County Government)

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Food Service Establishment Permit Application (Pinellas County Government)

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Pinellas County Utilities
Water Quality Division, Grease Management Program
Food Service Establishment Permit Application
SECTION A: INTRODUCTION
Your efforts as a Food Service Establishment partner will help us achieve the goal of
minimizing the accumulation of grease and food solids in our sanitary sewer system. This
commitment results in fewer sewer blockages and sanitary sewer overflows. The reduction in
overflows reduces public health nuisances and environmental degradation, and lowers the
cost of damage associated with sewer back-ups and sewer system maintenance.
• The Pinellas County Utilities Grease Management Program was established to keep Fats, Oils
and Grease (FOG) out of the sanitary sewer system. Pinellas County’s Grease Waste Ordinance,
Section 126-606, requires Food Service Establishment (FSE) within Pinellas County Utilities
retail or wholesale sewer service areas to obtain an annual permit. Grease Manage Program
personnel perform inspections at FSE’s to ensure compliance with the Grease Waste
Ordinance and to confirm grease removal devices are properly cleaned/pumped to keep FOG
out of the sanitary sewer system.
• Please select type/size of Trap or Interceptor at the FSE and note the associated annual permit
fee: [ ] Grease Trap – 50 gallons or less ($115.00)
[ ] Grease Interceptor – Greater than 50 gallons ($140.00)
• The Food Service Establishment will be mailed an invoiced for the annual permit fee.
(Do Not Send a Check with the application.)
• Regulatory requirements for FSE’s include weekly cleanings of 50 gallon or less grease traps,
and a monthly complete pump out of grease interceptors greater than 50 gallons.
• Please complete and return the Food Service Establishment Permit Application within
ten (10) days, of receipt (DATE: ____________________________________ ) and include the following:
1. Copy of water bill (if available)
2. Copy of last pump out receipt from registered hauler
Mail the completed application to:
Pinellas County Utilities, Water Quality Division
Grease Management Program
1620 Ridge Rd S, Bldg. A
Largo, FL 33778
-or-
Scan the completed application and email to: UTLGMP@pinellascounty.org
• If you have any questions or want to talk with a Grease Management Program Inspector please
contact them at (727) 582-2379. You can also go to the Pinellas County Utilities website at
www.pinellascounty.org/utilities/grease.htm for more information.
Page 1 of 3 6.12.2018
SECTION B: GENERAL INFORMATION
Please enter the Food Service Establishment’s official or legal name. Provide the physical
location of the establishment that is applying for Food Service Establishment permit.
1. Establishment Name: ______________________________________________________________
Establishment Street Address: ____________________________________________________
City: __________________________________State: ____________________ Zip: _______________
Phone Number: _______________________ Website: ___________________________________
Provide the business mailing address (if different from above) where correspondence (including
invoices) from Pinellas County should be sent. Note: Location must be able to accept Certified
Mail (may not use P.O. Box).
2. Name: _______________________________________________________________________________
Street: _______________________________________________________________________________
City: __________________________________State: ____________________ Zip: _______________
Phone Number: _______________________ Email: _____________________________________
Designated Contact for the Food Service Establishment: Please provide the name, telephone
number and email of the person who is:
• Familiar with the operation of the establishment (e.g. the owner or manager)
• Can be contacted by Pinellas County if enforcement actions are ever deemed necessary
This person will receive correspondence from the Grease Management Program.
3. Designated Establishment Contact:
Name: _________________________________________________________________________________
Title: ___________________________________________________________________________________
Phone Number: __________________________ Email: _____________________________________
Page 2 of 3 6.12.2018
SECTION C: TREATMENT
1. Complete the following for all grease traps/interceptors.
Number of grease traps/interceptors: ________________________________________________________
Make and Model: ________________________________________________________________________________
Capacity of grease trap/interceptor (in gallons): ____________________________________________
Location (kitchen, parking lot, etc.): ___________________________________________________________
____________________________________________________________________________________________________
2. If a contractor(s) cleans the grease trap/interceptor(s), please list the following:
Contractor Name: __________________________________________________________________________
Address: ___________________________________________________________________________________
City: ______________________________State: ____________________ Zip: ______
Phone Number: ________________________________________________________
3. How often is the grease trap/interceptor being cleaned / pumped? ___________________
Date of last cleaning/pump out: _____________________________________________________________
SECTION D: CERTIFICATION
I certify under penalty of law that the information submitted in this application is, to the best of
my knowledge and belief, true, accurate and complete. I agree to abide by the regulations
contained in the Pinellas County Code, Section 126-600 through 126-628, as well as any other
applicable Federal, State or Local regulations. I am aware that there are significant penalties
for submitting false information, including the possibility of fine and imprisonment for knowing
violations.
Name: _______________________________________________________________________________________________________
Title: _________________________________________________________________________________________________________
Signature ____________________________________ Date ________________________________________
Page 3 of 3 6.12.2018
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Food Service Establishment Permit Application (Pinellas County Government)

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Completed 15 February 2021

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